Provider Demographics
NPI:1306052808
Name:KORN, MELANIE BACAL (MD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:BACAL
Last Name:KORN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5150 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2812
Mailing Address - Country:US
Mailing Address - Phone:239-354-4311
Mailing Address - Fax:239-354-4310
Practice Address - Street 1:5150 TAMIAMI TRL N
Practice Address - Street 2:SUITE 302
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2812
Practice Address - Country:US
Practice Address - Phone:239-354-4311
Practice Address - Fax:239-354-4310
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME866682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD39070Medicare UPIN